Anthony Comfort of VisiQuate discusses opportunities for technology in healthcare, both in the clinical space and in revenue cycle

Anthony Comfort: It’s not just about the technology, like the hardware piece of technology. There are pieces of technology too from a people and process perspective that are really interesting.

Erika Grotto: Advancing the healthcare industry with targeted technological innovations, today on HFMA’s Voices in Healthcare Finance podcast, sponsored by BKD.

Hello, and welcome to the podcast. I’m your host, Erika Grotto. Today I’m talking with Anthony Comfort, from VisiQuate, about opportunities for technology to help tackle the industry’s greatest challenges. Later, I’ll be speaking with Brad Brotherton from BKD about what makes his firm stand out. But first, let’s find out what’s happening in healthcare finance news. Here’s HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack.

Nick Hut: Hey, everyone. We are recording this segment on the morning of Tuesday, April 19, and late in the afternoon on Monday the 18^th, CMS dropped the proposed rule for the Inpatient Prospective Payment System in FY23. So we thought we’d give our first impressions of some of the key points. According to the proposal, hospitals would get a 3.2% payment increase for inpatient services. That’s for hospitals that meet quality reporting requirements and don’t get penalized through the various pay-for-performance programs. The thing of it is that CMS projects at $1.6 billion increase in payments with the update, but it’s also saying Medicare disproportionate share hospital payments and uncompensated care payments will decrease by $800 million, as with add-on payments for new medical technologies. And Shawn, there are some other decreases in there, and for a large number of hospitals, it seems like we’re looking at a payment update that could be right around 0 or a net decrease. What are the ramifications of that, especially in the current environment?

Shawn Stack: Yeah, Nick. So the additional cuts will be a $600 million decrease due to the expiration of the low volume hospital and Medicare dependent hospital programs. So yeah, you’re right. The concern is that in the midst of digging ourselves out from a pandemic and COVID-19 still looming, hospitals are looking at a net decrease thanks to the CMS update. So a little shocking that CMS and Medicare would go this route given that hospitals and the healthcare trade have been very instrumental in key the last two years and our support and our dig-out from this pandemic. But it is what it is right now, and we’re expecting some pretty robust commenting on this significant payment decrease to hospitals over the next fiscal year.

Hut: Yeah, without question. And hospitals and other stakeholders have 60 days during which to make their feelings heard. Like you said, the comment period’s going to bear watching. One other noteworthy aspect regarding uncompensated care, which we mentioned, in FY23 according to the proposed rule, CMS would use two years rather than only one year as has been the case previously of audited data on uncompensated care costs from worksheet S-10 Medicare cost reports. Those two years would be FY18 and FY19, and for FY24, the proposal is for the number of years to go up to three. So this approach should lead to less variation in uncompensated care payments from one year to the next. Does that sound right, Shawn?

Stack: Yeah, I would agree. Using the greater span on data from the S-10 cost report, especially due to hospitals still wrapping their heads around that new S-10 report, that should help us with some unintended flexibility in that area and instability. Speaking of instability though, in common theme to all the other rules that have come out so far this year—the IPF, the IRF and the hospice—CMS has permanently capped decreases to hospital wage index at 5% in the IPPS rule as well. So this may help a little bit in some of that wavering wage index work that we’re seeing across different regions and within different areas of the country, but it still is budget neutral. And due to the fact of the way the pandemic rolled out and hit parts of the country much harder during that first six months than others, we still can see some pretty significant swings in wage index, and it will be very interesting to see how hospitals deal with that because some hospitals could be hit pretty hard due to the fact that CMS does not seem to be wavering on not making these adjustments non-budget neutral over the next year. So lots to watch here in wage index and a lot on the table to lose.

Hut: For sure. The budget neutral aspect is significant. I mean, that means, of course, that the funds to serve as a stopgap to larger wage index creases would have to come out of Medicare payments in some other way. So that definitely bears watching in coming years. And I know you wanted to touch on some key proposals related to value-based purchasing that we’re seeing in the rule.

Stack: Yeah, Nick. I mean, I personally was not very surprised at the hospital value-based purchasing program’s changes, but they are worth mentioning. Of course, all measures in its hospital acquired condition reduction program, they are beginning to suppress those again for the next fiscal year due to the pandemic, and as a result, hospitals would not experience fiscal year 2023 payment adjustments under either program. But CMS is proposing 10 new measures for the inpatient quality reporting program, including three related to equity-related measures and two perinatal electronic clinical quality measures. And then of course to increase the IQR programs reporting requirements from 4 to 6 beginning in the calendar year 2024. So I think these are all areas that we expected to see changes in and new developments on quality and especially health equity is extremely hot topic right now. And I know hospitals have been concurring for these changes as best they can in this last year. So we’ll be diving deep into those details over the next week. I’m sure you will be as well, Nick, but folks really need to look at those and comment appropriately.

Hut: Yeah, absolutely. And thanks, Shawn, for those insights, definitely. Something to keep in mind as you noted, all these proposals are just that for now. They’re proposals, and there’s a public comment period that runs through June 17, so most stakeholders have a chance to make their voice heard on the viability of this rule and some of the specific regulations that are included. And of course, we’ll be keeping you up to date at hfma.org/news.

Grotto: A few weeks ago on this podcast, I had a conversation with Michael Duke from Guidehouse about the dangers of adopting technology without knowing whether it will actually help solve the problem you’re trying to solve. Today’s guest is helping me answer the next logical question: Where are the biggest opportunities, those places where real improvements can be made with the help of technological innovations? And he has a lot of ideas. Here to talk with me is Anthony Comfort, executive vice president of product management and innovation at VisiQuate.  

The pandemic pushed the industry forward in many ways, but when it comes to technology and patient care, there are definitely some opportunities we’re taking advantage of that we weren’t before. And once you move past the consumerism and convenience and into patient care and outcomes, the population that seems to come up most often, at least in conversations I’ve had around this, is people with chronic conditions. Heart disease and diabetes are among the leading causes of death and disability in the U.S. They’re also leading drivers of high healthcare costs. So obviously, this is an important population to pay attention to. So tell me how technology can help improve the overall health of this patient population.

Comfort: Yeah, it’s a great question, and it’s such a timely problem, especially since so many patients during COVID, did not go seek out care for fear of entering a medical setting. And so, I think technology can really help in a couple of critical ways, and is helping in a few key ways right now. So in more recent times, we’ve definitely seen a variety of new types of Bluetooth-enabled blood glucose meters and continuous glucose monitors for the diabetic patient population that’s been coming into play. You know, Dexcom’s most recent CGM making it fairly easy and painless to install CGMs so that way, patients can, in real time, see exactly what their blood glucose or sugar levels are doing. And what’s more important is, because of that Bluetooth enablement being to communicate with an app on the phone and then being able to drive that data back to care providers, whether that is a physician, whether that be a care manager on either the provider or the payer side depending on patients’ care program, being able to see those insights quickly and then pair that with things like coaching or other types of AI assisted, digital assistance, pointing out to the patient where they need to make modifications to their behavior has been huge and will continue to explode as it ripples throughout the diabetic patient population as we move forward. And so I think that that’s one key way in which technology, especially with a lot of patients not going back to the endo in the case of the diabetic patient population is going to be a critical way for providers to get insights into how their patients are doing even when they’re not coming in, and more importantly, be able to make microadjustments in behavior. But as I mentioned, it’s not just about the technology, like the hardware piece of technology. There are pieces of technology too from a people and process perspective that are also really interesting in how they’re catering to these types of patient populations. So we’ve definitely seen over the past few years the rise of digital coaching and larger adoption from programs like Noom, for programs like INTERVENT and other service providers that exist out there that try to partner technology with humans to add a human touch to the coaching process to make sure that patients actually have somebody that they can work with on a day-to-day basis to seek remedies to everyday behavior that can have an impact on their health. And then finally, from a process perspective, it’s all about coordination. And so I think one of the trends that we’ve definitely seen over the past couple years—or I’d not quite call it a trend, but a potential of a trend emerging—is the emphasis placed on care continuity and the idea of handoff points between providers, between payers, and especially the rising popularity of IDNs as payers and providers begin to collaborate more and more, using technology to provide that type of care to the patient. And so I think there’s been a number of technology enablements on a number of different fronts, some that goes directly in the patients’ pocket or on their arm as it were, some as used by providers to enable care, some that’s even used by payers to better communicate and coordinate with providers that when you surround the patient with that ecosystem of technology makes it more manageable to manage chronic conditions like diabetes.

Grotto: You talked about technology helping sort of coordinate among not only patients and providers but payers, others working together to accomplish the goals that we’re talking about. And you hear a lot about healthcare being a team sport, but it’s also an industry that is notoriously siloed. So how can technology help bring all of these parties together?

Comfort: It’s such a good question. If I had to think about it, the first thing that comes to mind is the idea of transparency. There really needs to be a better way, or there really needs to continue to be a focus on how do we lift—to kind of make a conflict analogy here—how do we lift the fog of war between payers, providers, with ultimately the patient being in the middle, wandering around in the mist while payers and providers kind of try to figure each other out and maneuver in a way that allows them to continue to provide care and also stay in business at the same time. And so I think that this is definitely top of mind for many payers and providers right now. Nobody likes the way that that plays out, you know, save for maybe a few that exist out there—statistically you’ve got to chalk it up to that, of course. But examples that I see of where people are starting to come together and foster a greater sense of teamwork are—some health systems actually opening up—I know this is going to sound pretty radical, but they are doing this—but they’re opening up their billing platform in some way, shape or form to payers in order to get to a point of some type of real-time adjudication where payers can actually see what’s happening on the provider side, providers have more insight to what’s happening on the payer side, and you have a reduction in A/R days just simply by the fact that people actually know what each other’s doing and how they’re thinking in longer cycle times than, “I’m going to send over my appeal letter later, and I’ll hear back from you either 14 days from now, 30 days from now or maybe 45 days from now or maybe never, if something gets lost through the cracks. So I think transparency is one really critical area of focus, and platforms that exist out there that can do this are great, or just simple low-tech tricks like, hey, why don’t we just see what’s in each other’s systems and try to get to a state where we’re actually adjudicating things together rather than tossing stuff to each other over the proverbial wall.

Grotto: I’d really to hear your thoughts. It seems like workforce shortages, burnout enters every conversation that I’m having lately. What we seem to be learning is that we’re not going to be able to solve the workforce shortage issues by just doing more of what we’ve done in the past. That’s not going to make up for the difference. So technology also, really big opportunity here I think, in changing the way that we deliver care so that we can do it more efficiently with the people that we are able to have. So tell me about your thoughts on this one.

Comfort: From a productivity standpoint, it’s how do I get my people spending less time documenting every single thing that they’re doing and making it just more part of what they do in their daily interaction points? So stories that you hear about here are for clinicians, you hear about smart assistance sitting in the room with them, listening to what they’re doing and then converting that in real time into notes and then other systems at the same time converting those notes into actual clinical codes, DX codes, PX codes, CPT codes, HCPCS codes, the whole nine yards, fully end-to-end automated coding from the words coming out of the clinician’s mouth all the way to a properly coded claim. Now it’s not true for every single aspect of the clinical life cycle, but these technologies are actually starting to manifest themselves, taking a bullseye right onto the problem of burnout because physicians are now spending less time doing documentation, therefore becoming more productive in the super measure of how many patients are they having quality touches with. And on the back office side of the equation, same kind of concept. How do we get collectors, how do we get other revenue cycle team members, patient access folks, not sitting and going to 15 different payer portals to go get auths submitted and them documenting in shorthand notation all the little notes that they add to the account record, and then simultaneously going and pasting that into some other system, explaining what they did to an account. And so I think some of the things that you’re starting to see there is in interoperability language beginning to manifest itself is with either certain vendors creating different strategic alliances, larger vendors creating different strategic alliances to offer combined product packages that make that possible, EHRs in certain cases catching up and providing more of those features and functions directly to those types of staff members to avoid having to spend time on menial work and spending more time on solving problems with complex claims or whatever the case may be. On the process front, there’s been a very strong interest in the past few years, I would say two years—and this makes me really happy as a technologist and a self-avowed nerd—in process mining. And especially at an executive level, people really waking up to this technique, this domain of data science where we try to organize our data in a way that tells a story of what exactly happened to a claim, to an account, to an encounter over time, every single little touch that was made, and making sense of every single one of those touches. When I say “touch” in this case, it’s not just entering a note into the account, it’s the fact that you went to some portal to go do a claim status request, or that you received an automated claim status response about what actually happened or what the status of that claim is with a particular payer, of putting together this longitudinal artifactery of what happens to an account over time in a way that process mining tools and techniques can start to make sense of what is actually happening at the ground level of the processes that people are following and then using cool machine learning type technologies to sift back through that highly structured and groomed data at that point to figure out, what are all the different process paths that people are taking to get to a point where a claim has dispositioned as a zero balance from a revenue cycle perspective. And those kind of techniques and those kinds of tools are going to be game changers for finding new opportunities for automation, for figuring out the shorter paths to getting something done and ultimately removing administrative waste from the revenue cycle.

Grotto: Anthony Comfort, thank you so much for joining me on the podcast today.

Comfort: Absolutely, Erika. It was my pleasure.

Grotto: Let’s take a moment now to get a word from our sponsor, BKD. You might have heard BKD partner Danielle Solomon on our podcast last fall discussing innovation and disruption as part of our Healthcare 2030 series, which they also help support. Recently though, I got the chance to speak with Brad Brotherton, a partner with BKD and the firm’s healthcare regulatory practice leader, about what makes the firm unique and what’s on the horizon.

What makes BKD’s healthcare regulatory reimbursement consulting practice unique?

Brad Brotherton: Well, you know Erika, I probably think there’s quite a bit, but I’m going to comment on just a couple of things. BKD, we’re coming up on our 100-year anniversary, and for most of those years, we’ve been providing CPA services to healthcare clients. We’ve gained a lot of experience over this long time period, and when you combine that with our broad geographic footprint—we do serve clients in all 50 states—combining those things allows us to have insights into trends that we’re seeing across the country and react to them really timely. One of the things that I’ll mention just briefly is that the large size of our practice allows our team members to sub-specialize, so they’re working in special focus areas, like, they work only with academic medical centers, or they may only work with long-term care or home care organizations. So we try to bring that right level of expertise to all of our clients’ specific needs.

Grotto: BKD’s merger with DHG has been pretty big news lately. How will that merger impact the regulatory reimbursement practice?

Brotherton: Yeah. Thanks, Erika. Just to start off, we’re very excited about our planned merger of equals with DHG. We’re expecting that and plan on that being effective on June 1, and that’s going to make our new firm the eighth largest CPA firm in the country. So it’s super exciting from our end, but we’re most excited about the combination of those strengths between our firm and how it’s going to help us further serve our clients. It’s going to add to our number of team members, and a lot of additional expertise is going to be brought to the combined strengths. But we’re also going to want to look at, what are we doing well within each firm and where can we build on some of those opportunities. So one of the areas that we’re really excited about is our data analytic tools. We think that with the new merger, we’re going to have a lot more ability to accelerate in the data analytics space and get timely information into our clients’ hands.

Grotto: I know that’s definitely an area that a lot of listeners are probably, their ears probably perked up when you said “data analytics,” so certainly something that a lot of our members are looking at. What kind of changes do you foresee in the regulatory landscape, and how can BKD prepare clients?

Brotherton: Yes, certainly I think, like probably all industries, there’s so much change and increasing complexity these days that one of the things that we’re really seeing is the challenge with succession planning and how the training is going to be rolled out for the next generation of leaders. We’re actively working to develop training platforms, but one of the things that we’re focusing on is really a co-sourcing approach to working with our clients to identify where are they having a difficult time finding the right expertise or replacing some of that expertise that they had within their organization, and how can we help bring some of that to their reimbursement department? One of the other things that kind of goes hand in hand with a lot of this is, we have recently entered into a joint venture with HFS, and HFS is the software company that’s responsible for helping providers file about 80% of the Medicare cost reports. And so we created a joint venture to form a cloud-based cost reporting work paper tool called HFS Plus, powered by BKD. And it’s going to help efficiently and accurately pull information together out of accounting systems to put those cost reports together. And we think that at a time when there are increasing demands on people’s time and a challenge with succession planning is going to be a real opportunity for hospitals to capitalize on some of those challenges.

Grotto: Brad Brotherton, thank you so much for joining me today.

Brotherton: Sure, Erika. Appreciate it.

Grotto: BKD is a national CPA and advisory firm with 42 offices nationwide. BKD’s National Healthcare Group serves 4,000+ providers spanning the entire care continuum from stand-alone facilities to multi-billion-dollar, multi-state integrated delivery networks. These providers depend on BKD for assurance, tax, financial and strategic planning, regulatory & reimbursement services, and so much more. On June 1st of 2022, BKD will merge with DHG creating the 8th largest accounting firm in the country.

Voices in Healthcare Finance is a production of the Healthcare Financial Management Association, and written and hosted by me, Erika Grotto. Sound editing is by Linda Chandler. Brad Dennison is our director of content strategy. Our president and CEO is Joe Fifer. Thank you again to our sponsor for this week, BKD. Hot tip for any of you with certifications out there: I checked my status today and found out that my CRCR expires soon, so if that might be you too, get into that portal and start that recertification course. If you’re not certified yet, what are you waiting for? Certifications are included in your HFMA membership and you’ll be able to apply what you learn in your course right away. And while you’re sitting at your computer, send us an email. You can reach our team at [email protected].

On a recent episode of the “Voices in Healthcare Finance” podcast, Anthony Comfort, executive vice president of product management and innovation at VisiQuate, discussed what he sees as the greatest opportunities = for use of technology in healthcare.

Monitoring chronic conditions

Heart disease and diabetes are among the leading causes of death and disability in the United States as well as leading drivers of healthcare costs. According to Comfort, technology solutions that help patients and their physicians monitor their conditions consistently can result in better health outcomes. Real-time monitoring allows for adjustments in medications or behaviors, coupling technology with personal communication.

“We’ve definitely seen over the past few years the rise of digital coaching … and service providers that exist out there that try to partner technology [and] add a human touch to the coaching process,” Comfort said.

Communicating with payers

In an industry notorious for being siloed, technology can open the lines of communication between payers and providers as well, Comfort said.

“Some health systems [are] actually opening up … their billing platform in some way, shape or form to payers” to get to real-time adjudication where payers can actually see what’s happening on the provider side, he said. He acknowledged the idea as “radical” but said such systems allow for greater transparency and a reduction of A/R days.

Creating efficient processes

In a time when burnout and workforce shortages are of grave concern to healthcare providers, technology solutions can help create more efficient processes that increase productivity and satisfaction. And there are data analytics tools that are coming online that help track claims and trends.

“Those kind of techniques and those kinds of tools are going to be game changers for finding new opportunities for automation, for figuring out the shorter paths to getting something done and ultimately removing administrative waste from the revenue cycle,” he said.

Also in this episode

Brad Brotherton, a partner with podcast sponsor BKD, discussed what makes the accounting firm unique, and what’s on the horizon with BKD’s upcoming merger with DHG.